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Ischemic preconditioning and postconditioning in cardiovascular surgery

Year 2010, Volume: 32 Issue: 3, 365 - 373, 27.04.2010

İlker Şengül , Demet Şengül

Abstract

Abstract

Despite the technical improvements in the procedures of cardiovascular surgery; significant morbidity and mortality still continue in the patients undergoing cardiovascular surgery, especially in the high risk ones. Models of “conditioning” are suggested and evaluated as preserving the heart itself against ischemia - reperfusion injury which is an important cause of miyocardial injury created by the mentioned surgery and these models have been used in lots of experimental / clinical studies. In the mechanism of ischemic preconditioning; various systemic, chemical, physical stimuli, the substances affecting on the paired receptors of G - protein, proinflammatory substances, changes in the oxygen tension and various hypotheses were suggested such as protein kinase activation and activation of miyocardial potassium-ATP (KATP) channels. Lots of affirmative cardiovascular inteventions such as coronary artery bypass surgery, cardiac valve replacement, transplantation in vivo and vitro have been reported to benefit from the miyocardial preservation effect of ischemic preconditioning. Postconditioning have been widely used in various experimental / clinical studies such as acute miyocardial infarction, ventricular defibrillation, repair of tetralogy of Fallot and transplantation. Despite the fact that these “conditioning” phenomenons are promising, the demand for larger, multicenter, randomised, placebo - controlled experimental / clinical studies in this subject is increasing day by day.

 

Key words: Cardiovascular surgical procedure; conditioning; ischemic preconditioning; postconditioning; ischemia; reperfusion.

 

Özet

Kardiyovasküler cerrahi prosedürlerinde teknik ilerlemelere rağmen, hala kardiyovasküler cerrahiye giden - özellikle yüksek riskli – hastalarda, belirgin morbidite ve mortalite süregelmektedir. Anılan cerrahinin yarattığı miyokard hasarının ileri gelen nedeni olan iskemi – reperfüzyon hasarına karşı kalbin kendini koruması olarak bakılan “koşullanma” modelleri öne sürülmüş ve deneysel / klinik birçok çalışmada kullanılmıştır. İskemik önkoşullanmanın mekanizmasında; çok miktarda sistemik, kimyasal, fiziksel uyaran, G - proteinin çiftleşmiş reseptörleri üzerine etki eden maddeler, proinflamatuvar maddeler, oksijen tansiyonundaki değişimler ile birlikte protein kinaz aktivasyonu ve miyokardiyal potasyum - ATP (KATP) kanal aktivasyonu gibi daha birçok hipotez ileri sürülmüştür. İskemik önkoşullanmanın miyokard koruyuculuğu eylemi ile ilgili in vivo ve in vitro olmak üzere koroner arter “bypass” cerrahisi, kalp kapak replasmanı, transplantasyon gibi birçok olumlu kardiyovasküler cerrahi girişim raporlanmıştır. Sonradan koşullanma ise akut miyokard infarktüsü, ventriküler defibrilasyon, Fallot tetralojisi onarımı ve transplantasyon gibi alanlardaki deneysel / klinik birçok çalışmada geniş kullanım alanı bulmuştur. Bununla birlikte; bu “koşullanma” fenomenleri umut verici olsa da daha geniş, çok merkezli, randomize, placebo - kontrollü, deneysel ve klinik çalışmalara gereksinim gün geçtikçe artmaktadır.

 

Anahtar sözcükler: Kardiyovasküler cerrahi prosedür; koşullanma; iskemik önkoşullanma; sonradan koşullanma; iskemi; reperfüzyon.

Keywords

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References

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ISCHEMIC PRECONDITIONING AND POSTCONDITIONING IN CARDIOVASCULAR SURGERY

Year 2010, Volume: 32 Issue: 3, 365 - 373, 27.04.2010

İlker Şengül , Demet Şengül

Abstract

Although the technical developments in the procedures of cardiovascular surgery; significant morbidity and mortality stil continue in the patients undergoing cardiovascular surgery, especially in the high risk ones. Models of “conditioning” are suggested and evaluated as preserving the heart itself against ischemia – reperfusion injury which is an important cause of miyocardial injury is created by the mentioned surgery and they are used in lots of experimental / clinical study. In the mechanism of ischemic preconditioning; lots of systemic, chemical, physical stimulus, the substances affecting on the paired receptors of G – protein, proinflammatuar substances, changings in the tension of oxygen with the plenty of hypothesis such, protein kinase activation and activation of miyocardial potassium – ATP (KATP) channels are asserted. Lots of affirmative cardiovascular intevention such coronary artery bypass surgery, cardiac valve replacement, transplantation in vivo and vitro has been reported are related to act of miyocard preservation of ischemic preconditioning. Postconditioning have the area of usages in the lots of experimental / clinical study such, acute miyocardial infarction, ventricular defibrillation, repair of tetralogy of Fallot and transplantation. However, these “conditioning” phenomenons are hopeful, though the demand of larger, multidicipliner, randomised, placebo –  controlled experimental / clinical study is increasing day by day.

 

 

 

Keywords

Kardiyovasküler cerrahi prosedür koşullanma iskemik önkoşullanma sonradan koşullanma iskemi reperfüzyon

References

  • Valen G, Vaage J. Pre- and postconditioning during cardiac surgery. Basic Res Cardiol 2004-5;100:179-86.
  • Domenech R, Macho P. Non- ischemic myocardial preconditioning. Mol Cell Biochem 1998;186:201-3.
  • Yellon MD, Downey JM. Preconditioning the myocardim: from cellular physiology to clinical cardiology. Physiol Rev 2003;83:1113-51.
  • Sivaraman V, Hausenloy DJ, Kolvekar S, Hayward M, Yap J, Lawrence D, Di Salvo C, Yellon DM. The divergent roles of protein kinase C epsilon and delta in simulated ischaemia-reperfusion injury in human myocardium. J Mol Cell Cardiol 2009; 46: 758- 64.
  • Baxter GF, Ferdinandly P. Delayed preconditioning of myocardium: current perspectives. Basic Res Cardiol 2001; 96: 329-44.
  • Budas GR, Jovanovic S, Crawford RM, Jovanovic A. Hypoxia induced preconditioning in adult simulated cardiomyocytes is mediated by opening and trafficking of sarcolemmal K-ATP channel. FASEB J 2004;18: 1046-8.
  • Laude K, Beauchamp P, Thuillez C, Richard V. Endothelial effect of preconditioning. Cardiovasc Res 2002; 55: 466-73.
  • Marber MS. Ischemic preconditioning in isolated cells. Circ Res 1986;86:926-31.
  • Murphy E. Pimary and secondary signaling pathways in early preconditioning converge in mitochondria to produce cardioprotection. Circ Res 2004; 94: 7-16.
  • Gao X, Zhang H, Takahashi T, Hsieh J, Liao J, Steinberg GK, Zhao H. The Akt signaling pathway contributes to postconditioning's protection against stroke; the protection is associated with the MAPK and PKC pathways. J Neurochem 2008; 105: 943-55.
  • Rehni AK, Singh N. Role of phosphoinositide 3-kinase in ischemic postconditioning- induced attenuation of cerebral ischemia-evoked behavioral deficits in mice. Pharmacol Rep 2007; 59: 192-8.
  • Wojtovich AP, Brookes PS. The complex II inhibitor atpenin A5 protects against cardiac ischemia-reperfusion injury via activation of mitochondrial KATP channels. Basic Res Cardiol 2009; 104: 121-9.
  • Lamendola P, Di Monaco A, Barone L, Pisanello C, Lanza GA, Crea F. [Mechanisms of myocardial cell protection from ischemia/reperfusion injury and potential clinical implications]. G Ital Cardiol (Rome) 2009; 10: 28-36. [Article in Italian]
  • Valen G. Cellular signaling mechanisms in adaptaton of ischemia induced myocardial damage. Ann Med 2003; 35: 1-8.
  • Yellon DM, Dana A. The preconditioning phenomenon. A tool for scientist or a clinical reality? Circ Res 2000; 87: 543-50.
  • de Zeeuw S, Van den Doel MA, Duncker DJ, Verdouw PD. New insights into cardioprotection by ischemic preconditioning and other forms of stress. Ann N Y Acad Sci. 1999; 874: 178-91.
  • Şengül İ, Şengül D. İskemik ön koşullanma ve sonradan koşullanma mekanizmaları olarak intraselüler sinyalizasyon ve adenozin. Cumhuriyet Tıp Derg 2010; 32: 127-131.
  • Bopassa JC, Ferrera R, Gateau-Roesch O, Couture –Lepetit E, Ovize M. PI3-kinase regulates the mitochondrial transition pore in controlled reperfusion and postconditioning. Cardiovasc Res 2006; 69: 178-85.
  • Kolocassides KD, Galinanes M, Hearse D. İschemic preconditioning, cardioplegia or both? J Moll Cell Cardiol 1994; 26: 1411-14.
  • Takeshima S, Vaage J, Löwbeer C, Valen G. Does hypothermia or hypokalemia influence the preconditioning response? Scand Cardiovasc J 1999; 33: 79-87.
  • von Arnim CA, Etrich SM, Trimmler M, Riepe MV. Gender dependent hypoxic tolerance mediated via gender specific mechanisms. J Neurosci Res 2002; 68: 84-8.
  • Lee TM, Su SF, Tsai CC, LeeYT, Tsai CH. Cardioprotective effects of 17-β estradiol produced by activation of mitochondrial ATP-sensitive K channels in canine hearts. J Moll Cell Cardiol 2000; 32: 1147-58.
  • Shinmura K, Nagai M, Tamaki K, Bolli R. Gender and aging do not impare opioid- related preconditioning in rats. Basic Res Cardiol 2004; 99: 46-55.
  • Song X, Li g, Vaage J, Valen G. Effects of sex, gonadectomy and estrogen substitution on ischemic preconditioning and ischemia- reperfusion injury in mice. Acta Physiol Scand 2003; 177: 459-66.
  • Szekers L, Szilvassy Z, Ferdinandy P, Nagy I, Karcsu S, Csáti S. Delayed cardiac protection against harmfull consequences of stress can be induced in experimental atherosclerosis in rabbits. J Moll Cell Cardiol 1997; 29: 1977-83.
  • Li G, Tokuno S, Tahepold P, Vaage J, Löwbeer C, Valen G. Preconditioning protects the severely atherosclerotic mouse heart. Ann Thorac Surg 2001; 71: 1296-303.
  • Tokuna S, Hinokiyama K, Tokuna K, Löwbeer C, Valen G. Spontaneus ischemic events in the heart and brain precondition the hearts of severely atherosclerotic mice. Atheroscler Thromb Vasc Biol 2002; 22: 995-1001.
  • Mehta JL, Saldeen TGP, Rand K. Interactive role of infection, inflamation and traditional risk factors in atherosclerosis and coronary artery disease. Circ Res 1998; 31: 1217-25.
  • Abete P, Cacciatore F, Della Morte D, Mazzella F, Testa G, Galizia G, De Santis D, Longobardi G, Ferrara N, Rengo F. Joint effect of physical activity and body mass index on mortality for acute myocardial infarction in the elderly: role of preinfarction angina as equivalent of ischemic preconditioning. Eur J Cardiovasc Prev Rehabil 2009; 16: 73-9.
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There are 85 citations in total.

Details

Primary Language English
Journal Section Reviews
Authors

İlker Şengül

Demet Şengül

Publication Date April 27, 2010
Published in Issue Year 2010Volume: 32 Issue: 3

Cite

AMA Şengül İ, Şengül D. Ischemic preconditioning and postconditioning in cardiovascular surgery. CMJ. September 2010;32(3):365-373.